Toxidrome
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
A toxidrome (portmanteau of toxic and syndrome) is a syndrome caused by a dangerous level of toxins in the body. Common symptoms include dizziness, disorientation, nausea, vomiting, and oscillopsia. A toxidrome may indicate a medical emergency requiring treatment at a poison control center. Aside from poisoning, a systemic infection may also lead to a toxidrome.
The most common toxidromes are classified as:
Anticholinergic toxidrome
The symptoms of an anticholinergic toxidrome include blurred vision, choreoathetosis, coma, decreased bowel sounds, delirium, dry skin, fever, flushing, hallucinations, ileus, memory loss, mydriasis (dilated pupils), myoclonus, psychosis, seizures, and urinary retention. Complications include hypertension, hyperthermia, and tachycardia. Substances that may cause this toxidrome include antihistamines, atropine, benztropine, datura, tricyclic antidepressants, and scopolamine.
Due to the characteristic appearance and behavior of patients with this toxidrome, they are colloquially described as "Hot as a Hare, Dry as a Bone, Red as a Beet, Mad as a Hatter, Blind as a Bat".
Cholinergic toxidrome
The symptoms of a cholinergic toxidrome include bronchorrhea, confusion, defecation, diaphoresis, diarrhea, emesis, lacrimation, miosis, muscle fasciculations, salivation, seizures, urination, and weakness. Complications include bradycardia, hypothermia, and tachypnea. Substances that may cause this toxidrome include carbamates, mushrooms, and organophosphates.
A mnemonic device to remember the signs/symptoms of organophosphate toxicity is SLUDGE- Salivation, Lacrimation, Urination, Defecation, Gastrointestinal distress, and Emesis.
Hallucinogenic toxidrome
The symptoms of a hallucinogenic toxidrome include disorientation, hallucinations, hyperactive bowel sounds, panic, and seizures. Complications include hypertension, tachycardia, and tachypnea. Substances that may cause this toxidrome include amphetamines, cocaine, and phencyclidine.
Opiate toxidrome
The symptoms of an opiate toxidrome include altered mental states, miosis, shock, and unresponsiveness. Complications include bradycardia, hypotension, hypothermia, shallow respirations, and a slow respiratory rate. Substances that may cause this toxidrome include dextromethorphan, opiates, and propoxyphene.
Sedative/hypnotic toxidrome
The symptoms of a sedative/hypnotic toxidrome include ataxia, blurred vision, coma, confusion, delirium, deterioration of central nervous system functions, diplopia, dysesthesias, hallucinations, nystagmus, paresthesias, sedation, slurred speech, and stupor. Apnea is a potential complication. Substances that may cause this toxidrome include anticonvulsants, barbiturates, benzodiazepines, and ethanol.
Sympathomimetic toxidrome
The symptoms of a sympathomimetic toxidrome include anxiety, delusions, diaphoresis, hyperreflexia, mydriasis, paranoia, piloerection, and seizures. Complications include bradycardia, hypertension, and tachycardia. Substances that may cause this toxidrome include albuterol, amphetamines, cocaine, ephedrine (Ma Huang), methamphetamine, phenylpropanolamine (PPA's), and pseudoephedrine.